Be aware of potential IOL complications

December 1, 2010

The potential complications associated with implantation of phakic IOLs may give cataract surgeons a few challenges, but problems can often be averted with proper sizing and vaulting.

Phakic IOLs (pIOLs) come in many models, but each of these comes with its own list of possible challenges. The diagnosis and prevention of these problems is the responsibility of the cataract surgeon, said Dr Nick Mamalis, professor of ophthalmology and visual sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.

The pIOL models include anterior chamber anglesupported lenses, anterior chamber iris-fixated lenses and posterior chamber lenses. Although specific problems are associated with each type of lens, some complications are linked to pIOL surgery in general.

Proper vaulting, neither too steep nor too flat, is also essential for all pIOL models. Vaulting that is too steep may increase pigment dispersion and cause glaucoma, whereas vaulting that is too flat may lead to anterior subcapsular cataract formation.

"Any time we open an eye, endophthalmitis is a possibility," Dr Mamalis maintained. "This is exceedingly rare, but we still need to remember it."

He also stressed that patients who are highly myopic are at increased risk of retinal detachments, although such detachments are also rare and that toxic anterior segment syndrome may also occur.

"Despite their infrequency, these complications need to be mentioned when counselling patients." Dr Mamalis said.